Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis.

BACKGROUND: Surgery is the most important treatment modality for papillary thyroid cancer (PTC). However, the relationship between surgeon volume and long-term oncological outcomes has not been explored. METHODS: Patients diagnosed with N1b PTC after initial thyroid surgery between 1 July 1994 and 31 December 2011 were eligible for inclusion in the study. Surgeons were categorized into high (at least 100 operations per year) and low (fewer than 100 operations per year) volume groups. Kaplan-Meier survival analysis according to surgeon volume was performed, and Cox proportional hazard modelling was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals according to patient, tumour and surgeon factors. RESULTS: A total of 1103 patients with a median follow-up of 81 (i.q.r. 62-108) months were included in the study. During follow-up, 200 patients (18·1 per cent) developed structural recurrence. A high surgeon volume was associated with low structural recurrence (P = 0·006). After adjustment for age, sex and conventional risk factors for recurrence (histology, tumour size, gross extrathyroidal extension, margin status, more than 5 positive lymph nodes, radioactive iodine therapy), the adjusted HR for structural recurrence for low-volume surgeons was 1·46 (95 per cent c.i. 1·08 to 1·96), compared with high-volume surgeons. Distant metastasis (P = 0·242) and disease-specific mortality (P = 0·288) were not affected by surgeon volume. CONCLUSION: Surgeon volume is associated with structural recurrence, but not distant metastasis or cancer-specific death in patients with N1b PTC. Surgeon volume is important in initial surgery for advanced PTC with extensive nodal metastasis in order to ensure curative outcome and reduce treatment-related morbidity.

Nanoconfinement effects of chemically reduced graphene oxide nanoribbons on poly(vinyl chloride).

Polymeric nanocomposites with graphene-based nanocarbons (GNCs) have been extensively studied with emphasis on the percolation of nanofillers toward electrical, rheological, and mechanical reinforcement. In this study, we report an unusual indirect reinforcing phenomenon of highly defective GNCs dispersed in the poly(vinyl chloride) (PVC) matrix via densification of the polymer packing originating from nanoscale confinement. Herein, chemically reduced graphene oxide nanoribbons (C-rGONRs) are employed as a nanofiller. The inclusion of defective and oxygen-functionalized C-rGONRs resulted in a dramatic densification of the PVC host with extremely low C-rGONR loading, largely exceeding the theoretical calculation from a rule of mixture. Along with the densification, the glass transition temperature of PVC also increased by 28.6 °C at 0.1 wt% filler loading. Remarkably, the oxygen barrier property and mechanical toughness under tension for the PVC/C-rGONR nanocomposite were the maximum when the greatest densification occurred. The structure-property relationship of the nanocomposites has been discussed with an emphasis on the nanoscale confinement phenomenon.

Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma.

BACKGROUND: The patterns, predictive factors and prognostic impact of multilevel metastasis in patients with N1b papillary thyroid carcinoma (PTC) were investigated. METHODS: A retrospective review of patients with N1b PTC from a tertiary referral centre in Korea who underwent unilateral modified radical neck dissection was undertaken. RESULTS: Of 658 patients, multilevel metastasis was found in 73·9 per cent; the most common type was metastasis in two levels. Tumour size per 0·1-cm increment (adjusted odds ratio (OR) 1·33, 95 per cent c.i. 1·08 to 1·64), microscopic extrathyroidal extension (adjusted OR 1·72, 1·10 to 2·71), gross extrathyroidal extension (adjusted OR 2·35, 1·24 to 4·46), unilateral central lymph node metastasis (adjusted OR 2·45, 1·53 to 3·92) and bilateral central lymph node metastasis (adjusted OR 4·06, 2·29 to 7·18) were independent predictors of multilevel metastasis. Only four-level metastasis significantly increased the risk of overall locoregional recurrence (LRR) (adjusted hazard ratio (HR) 7·41, 95 per cent c.i. 2·20 to 24·53) and lateral neck LRR (adjusted HR 7·22, 1·82 to 28·65), compared with one-level metastasis. Two subgroup analyses were conducted, showing that only three-level metastasis including metastasis in level V significantly increased the risk of overall LRR (adjusted HR 5·66, 1·20 to 26·75). In addition, having level V metastasis was an independent predictor of both overall (adjusted HR 3·26, 1·72 to 6·18; P < 0·001) and lateral neck (adjusted HR 3·28, 1·50 to 7·16; P = 0·003) LRR. CONCLUSION: Level V metastasis rather than multilevel metastasis itself is associated with an increased risk of LRR. Patients with N1b PTC and level V metastasis require risk restratification and meticulous follow-up.

Estimation of pork quality traits using exsanguination blood and postmortem muscle metabolites.

The current study was designed to estimate the pork quality traits using metabolites from exsanguination blood and postmortem muscle simultaneously under the Korean standard pre- and post-slaughter conditions. A total of 111 Yorkshire (pure breed and castrated male) pigs were evaluated under the Korean standard conditions. Measurements were taken of the levels of blood glucose and lactate at exsanguination, and muscle glycogen and lactate content at 45 min and 24 h postmortem. Certain pork quality traits were also evaluated. Correlation analysis and multiple regression analysis including stepwise regression were performed. Exsanguination blood glucose and lactate levels were positively correlated with each other, negatively related to postmortem muscle glycogen content and positively associated with postmortem muscle lactate content. A rapid and extended postmortem glycolysis was associated with high levels of blood glucose and lactate, with high muscle lactate content, and with low muscle glycogen content during postmortem. In addition, these were also correlated with paler meat color and reduced water holding capacity. The results of multiple regression analyses also showed that metabolites in exsanguination blood and postmortem muscle explained variations in pork quality traits. Especially, levels of blood glucose and lactate and content of muscle glycogen at early postmortem were significantly associated with an elevated early glycolytic rate. Furthermore, muscle lactate content at 24 h postmortem alone accounted for a considerable portion of the variation in pork quality traits. Based on these results, the current study confirmed that the main factor influencing pork quality traits is the ultimate lactate content in muscle via postmortem glycolysis, and that levels of blood glucose and lactate at exsanguination and contents of muscle glycogen and lactate at postmortem can explain a large portion of the variation in pork quality even under the standard slaughter conditions.

Improved Survival with Anti-VEGF Therapy in the Treatment of Unresectable Appendiceal Epithelial Neoplasms.

BACKGROUND: Currently, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are accepted treatments for surgically resectable appendiceal epithelial neoplasms. However, for nonsurgical candidates, systemic treatment may be considered. The purpose of this analysis was to determine the benefit of biologic therapy (anti-vascular endothelial growth factor and anti-epidermal growth factor receptor) in addition to systemic chemotherapy in this select patient population. METHODS: The MD Anderson Cancer Center tumor registry was retrospectively reviewed for systemic treatment-naive appendiceal epithelial neoplasm patients registered between January 2000 to July 2007 for prior cytoreductive surgery and hyperthermic intraperitoneal chemotherapy status, histologic grade, signet ring pathology, systemic chemotherapy, biologic therapy, tumor markers (carcinoembryonic antigen, carbohydrate antigen [CA] 125, and/or CA19-9), progression-free survival (PFS), overall survival (OS), and disease control rate. Kaplan-Meier method, log-rank, and Cox proportional hazard regression models were used for statistical analysis. RESULTS: A total of 353 patients were identified; 130 patients met the inclusion criteria. Fifty-nine patients received biologic therapy. The use of the anti-vascular endothelial growth factor (VEGF) agent bevacizumab improved both OS (42 months vs. 76 months, hazard ratio 0.49 [95 % confidence interval 0.25-0.94] P = 0.03) and PFS (4 months vs. 9 months, hazard ratio 0.69 [95 % confidence interval 0.47-0.995], P = 0.047) for all histologic subtypes. Moderately differentiated tumors had an improved PFS relative to well-differentiated tumors, 9 months versus 3 months (P = 0.05). CONCLUSIONS: Bevacizumab in combination with chemotherapy appears to play a role in surgically unresectable appendiceal epithelial neoplasm patients, with an improvement in PFS and OS. Anti-VEGF agents should be strongly considered in the management of patients with higher-grade appendiceal epithelial neoplasms who are suboptimal candidates for surgical resection.

Association of blood glucose, blood lactate, serum cortisol levels, muscle metabolites, muscle fiber type composition, and pork quality traits.

The objective of this study was to investigate the relationship of blood glucose levels with blood lactate, serum cortisol levels, postmortem muscle glycogen and lactate content, muscle fiber type composition, and pork quality traits. Compared to pigs with lower blood glucose levels, pigs with higher blood glucose levels showed higher blood lactate and serum cortisol levels at exsanguination, and they had lower residual glycogen and higher lactate content in the muscle at 45min postmortem. In addition, pigs with higher blood glucose levels had higher type IIB and lower type I area composition and finally exhibited lower muscle pH, paler color, and excessive loss of fluid on surface. These results imply that measuring blood glucose levels at exsanguination can be useful to indicate early glycolytic rates during postmortem and thus may be of value in the identification of pork with undesirable quality traits.

Combined effects of potassium lactate and calcium ascorbate as sodium chloride substitutes on the physicochemical and sensory characteristics of low-sodium frankfurter sausage.

The purpose of this study was to evaluate the combined effects of sodium chloride (NaCl) substitutes, including potassium lactate (K-lactate) and calcium ascorbate (Ca-ascorbate), on the physicochemical and sensory characteristics of low-sodium frankfurter sausage (1.2% content of NaCl). Sausages produced with 40% substitution of NaCl with combined K-lactate and Ca-ascorbate showed a higher value of lightness (P<0.001) than sausages containing 2.0% content of NaCl (control). However, the sensory panels were unable to distinguish a difference in color intensity between the control and treatment groups. Frankfurter sausages produced with 30% K-lactate and 10% Ca-ascorbate exhibited similar water-holding capacity, textural properties, and organoleptic characteristics (P>0.05) when compared to control sausages. Thus, the use of these salt mixtures is a good way to reduce the NaCl content in meat products while maintaining the quality of meat products. These results may be useful in developing low-sodium meat products.

Muscle fiber characteristics of pectoralis major muscle as related to muscle mass in different Japanese quail lines.

The objectives of this study were to investigate the muscle fiber characteristics of the pectoralis major muscle, and its relation to growth performance in the random bred control (RBC) and heavy weight (HW) Japanese quail lines at 42 days of age. The HW line had greater body (232.0 v. 100.2 g, P < 0.001) and pectoralis major muscle (19.0 v. 6.2 g, P < 0.001) weights than the RBC line. Color differences were observed between the superficial and deep regions of the pectoralis major muscle, with the superficial region showing a higher value of lightness than the deep region of the RBC or HW lines (P < 0.001). The percentage of the superficial region in the pectoralis major muscle was higher in the HW line compared with the RBC line (46.2% v. 38.0%, P = 0.017). There were no significant differences in the total fiber number in the superficial and deep regions between the two quail lines (P = 0.718). The HW quail line showed a larger mean fiber cross-sectional area (CSA; 375.5 v. 176.6 µm², P < 0.001) and type IIA fiber CSA (243.7 v. 131.9 µm², P < 0.001) than the RBC quail line. The HW line also had greater CSA percentage (60.2% v. 34.2%, P < 0.001) and number percentage (41.6% v. 14.2%, P < 0.001) of type IIB fibers, although there were no significant differences in type IIB fiber CSA between the RBC and HW lines (P = 0.219). Therefore, greater body and muscle weights of the HW line are caused by differences in muscle fiber characteristics, especially the proportion of type IIB fiber and the CSA of type IIA fiber, compared with the RBC line. The results of this study suggest that muscle fiber hypertrophy has more impact on body and muscle weights of the different quail lines than muscle fiber hyperplasia.

Effects of muscle cortisol concentration on muscle fiber characteristics, pork quality, and sensory quality of cooked pork.

The effect of muscle cortisol concentration on muscle fiber characteristics and technological and sensory quality of pork was investigated. With the exception of the percentage of type IIA fibers, muscle fiber characteristics were not associated to cortisol levels. However, muscle cortisol concentration was positively associated with muscle pH(24h) (r = 0.23, P<0.05) and negatively associated with drip loss (r = -0.49, P<0.001), lightness (r = -0.24, P<0.05), shear force (r = -0.25, P<0.05), and texture profile analysis-hardness (r = -0.35, P<0.01). Additionally, the water-holding capacity of meat samples was affected by cortisol levels, with lower cortisol concentrations associated with less tender samples. These results indicate that the concentration of cortisol in the muscle is related with meat quality as well as the sensory quality of cooked pork.

Practical use of surimi-like material made from porcine longissimus dorsi muscle for the production of low-fat pork patties.

This study evaluates the effect of replacing fat with surimi-like material (SLM) made from the porcine longissimus dorsi muscle on the physicochemical and sensory characteristics of pork patties. Pork patties were produced with different levels of fat and SLM using a commercial method. Pork patties produced with 20% SLM had the lowest fat content (1.76%, P<0.001), and had a higher cooking yield (87.41 vs. 78.57%, P<0.05) and less shrinkage (4.01 vs. 9.02%, P<0.001) than patties produced with 20% back-fat (control). Moreover, patties produced with SLM exhibited more acceptable organoleptic characteristics, including tenderness (P<0.01) and overall acceptability (P<0.001), than full-fat control patties. These results indicated that SLM cannot only be used as a fat replacer, but that it also improves the physicochemical and sensory characteristics of low-fat pork patties.

The influence of pork quality traits and muscle fiber characteristics on the eating quality of pork from various breeds.

The purpose of this study was to compare parameters associated with pork quality, muscle fiber, and eating quality among various breeds, and to examine if differences in eating quality were associated to pork quality and muscle fiber characteristics. For carcass and pork quality, although there were significant differences among breeds, the values of parameters in all pigs were assigned a normal quality class, a likely outcome of the similarity in the area percentage of type I and IIB fibers. For eating quality, pork loins from Berkshire pigs were more tender and full of pork flavor than Landrace and Yorkshire pigs. Except juiciness and mouth coating, over 20% of the variability in the eating quality parameters can be explained by pork quality traits and muscle fiber characteristics using multiple regression analysis. Furthermore, differences in muscle pH(24h), cooking loss, shear force, and NPPC marbling score could explain a large proportion of variation in eating quality parameters associated with the texture of pork.

Effects of myosin heavy chain isoforms on meat quality, fatty acid composition, and sensory evaluation in Berkshire pigs.

The main objective of this study was to investigate the effects of myosin heavy chain (MHC) isoforms on meat and sensory quality in Berkshire pigs. A total of 85 pigs were evaluated, and muscle samples were taken for the analyses of MHC isoform, meat quality, fatty acid composition, and sensory evaluation. Content of the MHC slow isoform was significantly correlated with pH(24h) (r=0.26, P<0.05) and drip loss (r=-0.32, P<0.01), although the content of MHC isoforms showed limited relationships with individual fatty acids. In the case of sensory evaluation of meat by a trained panel test, the MHC fast/slow ratio was correlated with the juiciness (r=-0.33, P<0.01), off-flavor (r=0.34, P<0.01), tenderness attributes (r=-0.43 to -0.47). These results imply that the content of MHC isoforms can influence various aspects of quality including pork and sensory quality in Berkshire pigs.

Association between polymorphisms of the heart fatty acid binding protein gene and intramuscular fat content, fatty acid composition, and meat quality in Berkshire breed.

The objective of this study was to examine the relationship between polymorphisms of the heart fatty acid binding protein (H-FABP) gene and variation in intramuscular fat (IMF) content, fatty acid composition, and meat quality in Berkshire breed. We detected an association between IMF content and H-FABP HinfI restriction fragment length polymorphism (RFLP) genotype. The HH genotype showed the greatest IMF content among the genotype classes (P<0.05). Regarding meat quality traits, only drip loss was significantly different among the H-FABP HinfI RFLP genotype classes (P<0.01). In the case of fatty acid composition, the degree of saturation of fatty acids was greater in hh-genotype pigs than in HH and Hh genotypes. The H-FABP MspI RFLP genotype affected unsaturated fatty acid content, and the ratio of polyunsaturated fatty acid to saturated fatty acid (P<0.05), whereas the H-FABP HaeIII RFLP genotype had no effect on fatty acid characteristics.

Correlations of trained panel sensory values of cooked pork with fatty acid composition, muscle fiber type, and pork quality characteristics in Berkshire pigs.

The objective was to examine the relationship of trained panel sensory scores of cooked pork with fatty acid composition, muscle fiber type, and meat quality characteristics from Berkshire pigs. No or few associations were found between the panel sensory scores of cooked meat, especially tenderness attributes, and fatty acid composition; however, intramuscular fat content positively correlated with off-flavor score (r=0.31). On the other hand, the morphological characteristics of muscle fibers were correlated with panel sensory values. Muscles with smaller cross-sectional area and higher density of fibers were more closely associated with softer, more tender panel scores and a lower number of chews than muscles with larger fiber area and lower density of fibers. The water holding capacity test of filter-paper fluid uptake was moderately correlated with panel scores of softness (r=0.33), initial tenderness (r=0.38), chewiness (r=0.40), juiciness (r=-0.27), flavor intensity (r=-0.23), and off-flavor (r=0.30). Panel sensory values of Berkshire pig meat was moderately related to postmortem meat quality, especially water holding capacity. A more thorough understanding of the relationships between fatty acid composition and muscle fiber type with palatability is needed.

Sentinel lymph node biopsy in papillary thyroid cancer: comparison study of blue dye method and combined radioisotope and blue dye method in papillary thyroid cancer.

AIM: Occult lymph node metastasis is common in differentiated thyroid cancer (DTC). However, the role of lymph node dissection in the treatment of DTC remains controversial. The authors investigated the usefulness of methylene blue dye only method and combined radioisotope and methylene blue dye method for detecting SLN and compared the values of these two methods in patients with DTC. METHODS: From February to May 2008, 97 patients with DTC underwent sentinel lymph node biopsy (SLNB). The methylene blue dye method (dye only method) was used in 54 of the 97 patients, and radioisotope and methylene blue dye method (combined method) in 43 patients. RESULTS: The SLNs were identified in 89 patients, and the sensitivity and specificity of SLNB in the 97 patients were 85% and 100% respectively. For the dye only method, sensitivity, specificity, and the false negative rate (FNR) were 79%, 100%, and 21%; and for the combined method (43 patients) the corresponding figures were, 91%, 100%, and 9%, respectively. Six patients with SLN metastasis in the lateral neck underwent additional modified radical neck dissection (MRND). CONCLUSIONS: SLNB was found to be feasible, repeatable, and accurate in evaluating the lymph node status in patient with DTC. The present study indicates that the combined method could reduce false negative rate and increase detection rates of sentinel lymph node metastases, especially in lateral neck, compared to the dye only method.

Sensory evaluations of porcine longissimus dorsi muscle: Relationships with postmortem meat quality traits and muscle fiber characteristics.

The objective of this study was to investigate sensory evaluations and their relationships with meat quality measurements and histochemical characteristics in both fresh and cooked pork. Based on the results, postmortem meat quality traits were closely related to almost all the evaluated sensory attributes. With regard to histochemical characteristics, muscle fiber area was related to both fresh- (r=0.18, P<0.05) and cooked-meat color (r=-0.24, P<0.01) as well as abnormal flavor intensity (r=0.25, P<0.01), and muscle fiber composition was associated with fresh pork color and taste acceptability after cooking. There were no significant relationships (P>0.05) between type IIa muscle fiber content and the evaluated sensory attributes; however, good meat sensory quality was partially explained by the percentage of type I fiber.

The relation of blood glucose level to muscle fiber characteristics and pork quality traits.

The purpose of this study was to examine the relationships between blood glucose level, muscle fiber characteristics, and pork quality. Muscle samples were classified into three groups based on blood glucose level measured at slaughter. Pigs with higher area percentages of fiber type IIB showed higher blood glucose levels compared to pigs with lower area percentages of fiber type IIB. The high blood glucose level group presented lower pH values at 45min and 24h postmortem, and also had higher L(∗) values and reduced water holding capacity. In addition, blood glucose level had a negative relationship with pH(45min) and the solubility of sarcoplasmic and myofibrillar proteins, whereas it had a positive relationship with drip loss and filter-paper fluid uptake. In conclusion, blood glucose level was related to muscle fiber area composition and could partially indicate ultimate pork quality.

The relation between glycogen, lactate content and muscle fiber type composition, and their influence on postmortem glycolytic rate and pork quality.

This study examined the relation between glycogen, lactate content and muscle fiber type composition, and evaluated their influence on postmortem glycolytic rate and meat quality. Muscle samples were classified based on their glycogen and lactate content at 45min postmortem. Muscles with low glycogen and high lactate levels showed low muscle pH(45min) and high R-values. However, muscles with low glycogen and lactate levels showed normal rates of postmortem glycolysis and normal meat quality. On the other hand, muscles with high glycogen and lactate content showed rapid postmortem glycolysis, paler surface color, higher drip loss, and higher extents of protein denaturation than muscles with high glycogen and low lactate content. These results may be partially explained by muscle fiber type composition. Muscles with low glycogen and lactate content at early postmortem are composed of significantly higher fiber type I and lower fiber type IIB as compared to muscles with high glycogen and lactate content.

Comparing the histochemical characteristics and meat quality traits of different pig breeds.

The purpose of this study was to compare the muscle histochemical characteristics and meat quality traits between Berkshire, Landrace, Yorkshire, and crossbred pigs. A total of 594 pigs were evaluated. A clear difference between histochemical properties was observed from the results for fiber type composition. In Berkshire pigs, the area percentage of type I fibers was higher (P<0.001) and that of type IIb fibers was lower (P<0.05) than those of other breeds. The muscle pH(45min) and pH(24h) were significantly higher in Berkshire pigs. Drip loss and color parameters were significantly different between the breeds (P<0.001). The Berkshire pigs, which showed the highest muscle pH and lowest drip loss and L(∗) values, contained a significantly higher percentage of type I fibers than the other breeds. By comparing the fiber type compositions of the different breeds, the results imply that the longissimus dorsi muscle of Berkshire pigs is more oxidative than that of other breeds. A high pH value in Berkshire pigs is due to a high percentage of type I fibers and a low percentage of type IIb fibers. Based on these results, we conclude that muscle fiber composition can explain in parts the variation of meat quality across and within breeds.

Quantification of proteinuria in children using the urinary protein-osmolality ratio.

A prospective study was conducted to determine the correlation of early morning urinary protein/osmolality ratio (mg/l/mosmol/kg) with 24-h urinary protein excretion (mg/m2/day). Study patients consisted of 53 children (aged 1 month to 15 years). Early morning urine samples and 24-h urine samples were collected and analyzed. In group 1 (children without proteinuria), early morning urinary protein/creatinine ratio (Uprot/Ucr, mg/mg) was 0.061 +/- 0.011 and the protein/osmolality ratio (Uprot/Uosm, mg/l/mosmol/kg) was 0.073 +/- 0.014. Twenty-four hour urinary protein excretion in group 1 had no significant correlation with Uprot/Ucr or Uprot/Uosm. In group II (children with proteinuria), Uprot/Ucr was 5.78 +/- 1.10 and Uprot/Uosm was 4.42 +/- 1.34. Twenty-four hour urinary protein excretion in group 2 was 1483.6 +/- 303.7 mg/m2/day and its correlation with both Uprot/Uosm and Uprot/Ucr was highly significant (r = 0.87, P < 0.001 and r = 0.88, P < 0.001, respectively). The accepted nephrotic level of proteinuria of 40 mg/m2/h coincides with a Uprot/Uosm ratio of 1.9. In conclusion, early morning urinary Uprot/Uosm is a simple and potentially useful test for 24-h urinary protein excretion, and possibly could be used safely for the assessment of the degree of proteinuria in children.